Epic man, singing about immediate release of results, covers Anticipatory Guidance.

Thanks to Dr. Jennifer Kemp who designed and invited me to present a panel called: “Information Blocking Pro and Con: A Debate.”

I am at RSNA today. My first. Did you know the Radiological Society of North America is the largest medical conference in the world? I did not know this until yesterday. 40,000 attendees, over 4000 speakers. That works out to about 80 speakers PER HOUR. Geez.

I was one.

Disappointingly, not all 40,000 attendees came to see our panel presentation. 🙁

Nevertheless, of the 80 attendees, we had an excellent discussion in the context of releasing complex radiology images to patients, including MRI CT PET etc. and the resulting problems if/when patients find out about cancer or other devastating result by viewing their results online.

There are exceptions to the federal rule:

If the patient prefers not to see the results
If releasing the results may result in Physical Harm to the patient or other person (note that anxiety or psychological harm does NOT qualify)
Systematic embargo or delay of release of result is forbidden based on this federal rule.
The proposed penalty for violating this rule is $1 million. However, we are aware of only about 400 registered complaints of information blocking, 3/4 of which are organization to organization blocking, and only about 100 of patients registering because of not receiving notes or results. And we are not aware of any successful complaints resulting in actual penalties, as yet.

Question from the UK

We had a question from a colleague from the United Kingdom, as they are just now about to formulate a similar law. ‘Would it be reasonable given US experience to establish a national standard for embargo: let’s say all providers uniformly delay a high risk result for 3 days?’

Our reply: probably not. Airline passengers are now aware of every moment of their luggage transport, and every moment of their arriving Uber driver. Why would radiology reports be any different? The consumerism movement is unidirectionally toward more transparency. Maybe 5 years ago, if the UK was considering a standard, that would have been standard of care in the US, but no longer.

Furthermore, research that we (reference) did

indicate that among 8000 patients who had already received test results from a patient portal, 96% indicated they wished to continue to receive results immediately. Even among those receiving abnormal results, 95% still wished to receive results immediately.

It is also true, however, that 8% of patients receiving immediately released results did worry more. However, we believe this worry is based on getting “bad news” more than it is about getting “bad news immediately.” These are the patients we need to focus on, and more details we need to study.

Our suggested plan: that ordering physicians use anticipatory guidance: ordering physicians will eventually need to explain the result to the patient. Why not spend one more minute at the time of ordering to dramatically reduce the anxiety of the patient when they view the result later at home?

3 easy steps:

1. We are ordering a test. You may see the result before me. Best case, this is normal and I will contact you this way…

2. Worst case it could be … there is X% chance of this. If that is the case this is how I would reach you…

3. You have a choice: look immediately or wait to hear from me. What Q do you have?

In our experience this works very well and doesn’t take much time at all.

And for radiologists, publishing a contact number for patients to call if they have questions is very reassuring to patients and, guess what: they rarely use that number: in a busy multi-radiologist practice over the course of years reading hundreds of thousands of studies, their office has received 1-3 phone calls A YEAR from patients. And most of the time it is about factual errors in the report, and rarely is it to ask about the medical impact of the findings. It is quite minimal work.